An exploration of critical thinking and processing in cardiac nurses' practice

Abstract

The need and demand for critical thinking in cardiac nursing and practice in general is well documented in the nursing literature. However, little attention has been given to solidifying a definition or describing critical thinking as it occurs in practice. In an initial fieldwork project of one experienced nurse in a cardiac rehabilitation setting, an eight-phase process (reference point, congruency check, active questioning, additional gathering, cueing congruency, weighing and selection, action and follow-up/self-evaluation) was identified. It involved both mental and behavioral activities and prompted the renaming of critical thinking to critical processing, as a more encompassing label. ^ The aim of this study was to observe the nature of critical processing in the practice of four experienced cardiac nurses through participant observation. Three periods of two-hour observation and informal interviews were followed by one-hour formal interviews in an outpatient cardiac rehabilitation unit of a suburban for-profit hospital in New England over a period of nine months. ^ Of twenty-five problematic situations that were recorded and analyzed, ten were found to be congruent with seven of the eight phases depicted in the fieldwork project. The initial reference point phase was reconceptualized as a pre-condition since nurses developed a reference point for all patients and then drew on this base for the congruency check, once a problematic situation had been identified. Also, some evidence of other types of thinking and processing (e.g. nursing process) were found in practice. Future research needs to focus on identifying outcomes, examining critical processing in other practice settings and empirically separating critical processing from nursing process. ^